Current status of magnetic resonance imaging radiomics in hepatocellular carcinoma:A quantitative review with Radiomics Quality Score

BACKGROUND Radiomics is a promising tool that may increase the value of magnetic resonance imaging(MRI)for different tasks related to the management of patients with hepatocellular carcinoma(HCC).However,its implementation in clinical practice is still far,with many issues related to the methodological quality of radiomic studies.AIM To systematically review the current status of MRI radiomic studies concerning HCC using the Radiomics Quality Score(RQS).METHODS A systematic literature search of PubMed,Google Scholar,and Web of Science databases was performed to identify original articles focusing on the use of MRI radiomics for HCC management published between 2017 and 2023.The methodological quality of radiomic studies was assessed using the RQS tool.Spearman’s correlation(ρ)analysis was performed to explore if RQS was correlated with journal metrics and characteristics of the studies.The level of statistical significance was set at P<0.05.RESULTS One hundred and twenty-seven articles were included,of which 43 focused on HCC prognosis,39 on prediction of pathological findings,16 on prediction of the expression of molecular markers outcomes,18 had a diagnostic purpose,and 11 had multiple purposes.The mean RQS was 8±6.22,and the corresponding percentage was 24.15%±15.25%(ranging from 0.0% to 58.33%).RQS was positively correlated with journal impact factor(IF;ρ=0.36,P=2.98×10^(-5)),5-years IF(ρ=0.33,P=1.56×10^(-4)),number of patients included in the study(ρ=0.51,P<9.37×10^(-10))and number of radiomics features extracted in the study(ρ=0.59,P<4.59×10^(-13)),and time of publication(ρ=-0.23,P<0.0072).CONCLUSION Although MRI radiomics in HCC represents a promising tool to develop adequate personalized treatment as a noninvasive approach in HCC patients,our study revealed that studies in this field still lack the quality required to allow its introduction into clinical practice.

What benefit can be obtained from magnetic resonance imaging diagnosis with artificial intelligence in prostate cancer compared with clinical assessments?

The present study aimed to explore the potential of artificial intelligence(AI)methodology based on magnetic resonance(MR)images to aid in the management of prostate cancer(PCa).To this end,we reviewed and summarized the studies comparing the diagnostic and predictive performance for PCa between AI and common clinical assessment methods based on MR images and/or clinical characteristics,thereby investigating whether AI methods are generally superior to common clinical assessment methods for the diagnosis and prediction fields of PCa.First,we found that,in the included studies of the present study,AI methods were generally equal to or better than the clinical assessment methods for the risk assessment of PCa,such as risk stratification of prostate lesions and the prediction of therapeutic outcomes or PCa progression.In particular,for the diagnosis of clinically significant PCa,the AI methods achieved a higher summary receiver operator characteristic curve(SROC-AUC)than that of the clinical assessment methods(0.87 vs.0.82).For the prediction of adverse pathology,the AI methods also achieved a higher SROC-AUC than that of the clinical assessment methods(0.86 vs.0.75).Second,as revealed by the radiomics quality score(RQS),the studies included in the present study presented a relatively high total average RQS of 15.2(11.0–20.0).Further,the scores of the individual RQS elements implied that the AI models in these studies were constructed with relatively perfect and standard radiomics processes,but the exact generalizability and clinical practicality of the AI models should be further validated using higher levels of evidence,such as prospective studies and open-testing datasets.

Feasibility of 3.0 T diffusion-weighted nuclear magnetic resonance imaging in the evaluation of functional recovery of rats with complete spinal cord injury

Diffusion tensor imaging is a sensitive way to reflect axonal necrosis and degeneration, glial cell regeneration and demyelination following spinal cord injury, and to display microstructure changes in the spinal cord in vivo. Diffusion tensor imaging technology is a sensitive method to diagnose spinal cord injury; fiber tractography visualizes the white matter fibers, and directly displays the structural integrity and resultant damage of the fiber bundle. At present, diffusion tensor imaging is restricted to brain examinations, and is rarely applied in the evaluation of spinal cord injury. This study aimed to explore the fractional anisotropy and apparent diffusion coefficient of diffusion tensor magnetic resonance imaging and the feasibility of diffusion tensor tractography in the evaluation of complete spinal cord injury in rats. The results showed that the average combined scores were obviously decreased after spinal cord transection in rats, and then began to increase over time. The fractional anisotropy scores after spinal cord transection in rats were significantly lower than those in normal rats （P 〈 0.05）; the apparent diffusion coefficient was significantly increased compared with the normal group （P 〈 0.05）. Following spinal cord transection, fractional anisotropy scores were negatively correlated with apparent diffusion coefficient values （r = -0.856, P 〈 0.01）, and positively correlated with the average combined scores （r = 0.943, P 〈 0.01）, while apparent diffusion coefficient values had a negative correlation with the average combined scores （r = -0.949, P 〈 0.01）. Experimental findings suggest that, as a non-invasive examination, diffusion tensor magnetic resonance imaging can provide qualita- tive and quantitative information about spinal cord injury. The fractional anisotropy score and apparent diffusion coefficient have a good correlation with the average combined scores, which reflect functional recovery after spinal cord injury.

In vivo tracking of human adipose-derived stem cells labeled with ferumoxytol in rats with middle cerebral artery occlusion by magnetic resonance imaging

Ferumoxytol, an iron replacement product, is a new type of superparamagnetic iron oxide ap- proved by the US Food and Drug Administration. Herein, we assessed the feasibility of tracking transplanted human adipose-derived stem cells labeled with ferumoxytol in middle cerebral artery occlusion-injured rats by 3.0 T MRI in vivo. 1 × 104 human adipose-derived stem cells labeled with ferumoxytol-heparin-protamine were transplanted into the brains of rats with middle cerebral artery occlusion. Neurologic impairment was scored at 1, 7, 14, and 28 days after transplantation. T2-weighted imaging and enhanced susceptibility-weighted angiography were used to observe transplanted cells. Results of imaging tests were compared with results of Prussian blue staining. The modified neurologic impairment scores were significantly lower in rats transplanted with cells at all time points except I day post-transplantation compared with rats without transplantation. Regions with hypointense signals on T2-weighted and enhanced susceptibility-weighted angiography images corresponded with areas stained by Prussian blue, suggesting the presence of superparamagnetic iron oxide particles within the engrafted cells. Enhanced susceptibility-weighted angiography image exhibited better sensitivity and contrast in tracing ferumoxytol-heparin-protamine-labeled human adipose-derived stem ceils compared with T2-weighted imaging in routine MRI.

Correlation of lumbar lateral recess stenosis in magnetic resonance imaging and clinical symptoms

AIM To assess the correlation of lateral recess stenosis(LRS) of lumbar segments L4/5 and L5/S1 and the Oswestry Disability Index(ODI).METHODS Nine hundred and twenty-seven patients with history of low back pain were included in this uncontrolled study.On magnetic resonance images(MRI) the lateral recesses(LR) at lumbar levels L4/5 and L5/S1 were evaluated and each nerve root was classified into a 4-point grading scale(Grade 0-3) as normal,not deviated,deviated or compressed.Patient symptoms and disability were assessed using ODI.The Spearman's rank correlation coefficient was used for statistical analysis(P < 0.05).RESULTS Approximately half of the LR revealed stenosis(grade 1-3;52% at level L4/5 and 42% at level L5/S1) with 2.2% and 1.9% respectively reveal a nerve root compression.The ODI score ranged from 0%-91.11% with an arithmetic mean of 34.06% ± 16.89%.We observed a very weak statistically significant positive correlation between ODI and LRS at lumbar levels L4/5 and L5/S1,each bilaterally(L4/5 left:rho < 0.105,P < 0.01;L4/5 right:rho < 0.111,P < 0.01;L5/S1 left:rho 0.128,P < 0.01;L5/S1 right:rho < 0.157,P < 0.001).CONCLUSION Although MRI is the standard imaging tool for diagnosing lumbar spinal stenosis,this study showed only a weak correlation of LRS on MRI and clinical findings.This can be attributed to a number of reasons outlined in this study,underlining that imaging findings alone are not sufficient to establish a reliable diagnosis for patients with LRS.

Faecal calprotectin and magnetic resonance imaging in detecting Crohn's disease endoscopic postoperative recurrence

AIM To assess magnetic resonance imaging(MRI) and faecal calprotectin to detect endoscopic postoperative recurrence in patients with Crohn's disease(CD).METHODS From two tertiary centers, all patients with CD who underwent ileocolonic resection were consecutively and prospectively included. All the patients underwent MRI and endoscopy within the first year after surgery or after the restoration of intestinal continuity [median = 6 mo(5.0-9.3)]. The stools were collected the day before the colonoscopy to evaluate faecal calprotectin level. Endoscopic postoperative recurrence(POR) was defined as Rutgeerts' index ≥ i2b. The MRI was analyzed independently by two radiologists blinded from clinical data.RESULTS Apparent diffusion coefficient(ADC) was lower in patients with endoscopic POR compared to those with no recurrence(2.03 ± 0.32 vs 2.27 ± 0.38 × 10^(-3) mm^2/s, P = 0.032). Clermont score(10.4 ± 5.8 vs 7.4 ± 4.5, P = 0.038) and relative contrast enhancement(RCE)(129.4% ± 62.8% vs 76.4% ± 32.6%, P = 0.007) were significantly associated with endoscopic POR contrary to the magnetic resonance index of activity(Ma RIA)(7.3 ± 4.5 vs 4.8 ± 3.7; P = 0.15) and MR scoring system(P = 0.056). ADC < 2.35 × 10^(-3) mm^2/s [sensitivity = 0.85, specificity = 0.65, positive predictive value(PPV) = 0.85, negative predictive value(NPV) = 0.65] and RCE > 100%(sensitivity = 0.75, specificity = 0.81, PPV = 0.75, NPV = 0.81) were the best cutoff values to identify endoscopic POR. Clermont score > 6.4(sensitivity = 0.61, specificity = 0.82, PPV = 0.73, NPV = 0.74), Ma RIA > 3.76(sensitivity = 0.61, specificity = 0.82, PPV = 0.73, NPV = 0.74) and a MR scoring system ≥ MR1(sensitivity = 0.54, specificity = 0.82, PPV = 0.70, and NPV = 0.70) demonstrated interesting performances to detect endoscopic POR. Faecal calprotectin values were significantly higher in patients with endoscopic POR(114 ± 54.5 μg/g vs 354.8 ± 432.5 μg/g; P = 0.0075). Faecal calprotectin > 100 μg/g demonstrated high performances to detect endoscopic POR(sensitivity = 0.67, specificity = 0.93, PPV = 0.89 and NPV = 0.77).CONCLUSION Faecal calprotectin and MRI are two reliable tools to detect endoscopic POR in patients with CD.

Impact of cognition-related single nucleotide polymorphisms on brain imaging phenotype in Parkinson’s disease

Multiple single nucleotide polymorphisms may contribute to cognitive decline in Parkinson’s disease. However, the mechanism by which these single nucleotide polymorphisms modify brain imaging phenotype remains unclear. The aim of this study was to investigate the potential effects of multiple single nucleotide polymorphisms on brain imaging phenotype in Parkinson’s disease. Forty-eight Parkinson’s disease patients and 39 matched healthy controls underwent genotyping and 7 T magnetic resonance imaging. A cognitive-weighted polygenic risk score model was designed, in which the effect sizes were determined individually for 36 single nucleotide polymorphisms. The correlations between polygenic risk score, neuroimaging features, and clinical data were analyzed. Furthermore, individual single nucleotide polymorphism analysis was performed to explore the main effects of genotypes and their interactive effects with Parkinson’s disease diagnosis. We found that, in Parkinson’s disease, the polygenic risk score was correlated with the neural activity of the hippocampus, parahippocampus, and fusiform gyrus, and with hippocampal-prefrontal and fusiform-temporal connectivity, as well as with gray matter alterations in the orbitofrontal cortex. In addition, we found that single nucleotide polymorphisms in α-synuclein(SNCA) were associated with white matter microstructural changes in the superior corona radiata, corpus callosum, and external capsule. A single nucleotide polymorphism in catechol-O-methyltransferase was associated with the neural activities of the lingual, fusiform, and occipital gyri, which are involved in visual cognitive dysfunction. Furthermore, DRD3 was associated with frontal and temporal lobe function and structure. In conclusion, imaging genetics is useful for providing a better understanding of the genetic pathways involved in the pathophysiologic processes underlying Parkinson’s disease. This study provides evidence of an association between genetic factors, cognitive functions, and multi-modality neuroimaging biomarkers in Parkinson’s disease.

Clinical and prostate multiparametric magnetic resonance imaging findings as predictors of general and clinically significant prostate cancer risk:A retrospective single-center study

Background:To evaluate the predictive values of Prostate Imaging Reporting and Data System version 2(PI-RADS v2),prostate-specific antigen(PSA)level,PSA density(PSAD),digital rectal examination findings,and prostate volume,individually and in combination,for the detection of prostate cancer(Pca)in biopsy-naïve patients.Methods:We retrospectively analyzed 630 patients who underwent transrectal systematic prostate biopsy following prostate multiparametric magnetic resonance imaging.A standard 12-core biopsy procedure was performed.Univariate and multivariate analyses were performed to determine the significant predictors of clinically significant cancer but not Pca.Results:The median age,PSA level,and PSAD were 70 years,8.6 ng/mL,and 0.18 ng/mL/mL,respectively.A total of 374(59.4%)of 630 patients were biopsy-positive for Pca,and 241(64.4%)of 374 were diagnosed with clinically significant Pca(csPCa).The PI-RADS v2 score and PSAD were independent predictors of Pca and csPCa.The PI-RADS v2 score of 5 regardless of the PSAD value,or PI-RADS v2 score of 4 plus a PSAD of<0.3 ng/mL/mL,was associated with the highest csPCa detection rate(36.1%-82.1%).Instead,the PI-RADS v2 score of<3 and PSAD of<0.3 ng/mL/mL yielded the lowest risk of csPCa.Conclusion:The combination of the PI-RADS v2 score and PSAD could prove to be a helpful and reliable diagnostic tool before performing prostate biopsies.Patients with a PI-RADS v2 score of<3 and PSAD of<0.3 ng/mL/mL could potentially avoid a prostate biopsy.

Multiparametric MRI reporting using Prostate Imaging Reporting and Data System version 2.0 (PI-RADSv2) retains clinical efficacy in a predominantly post-biopsy patient population

Objective:To evaluate the efficacy of multiparametric magnetic resonance imaging(mp-MRI)using Prostate Imaging Reporting and Data System version 2.0(PI-RADSv2)definitions in detecting organ-confined prostate cancer.Methods:All patients who underwent radical prostatectomy between January 1,2014 and December 30,2014 were identified.All underwent mp-MRI within 180 days before surgery.Those with prior pelvic irradiation or androgen deprivation therapy were excluded.Fully embedded,whole-mount histopathology was centrally reviewed and correlated with imaging for tumour location,Gleason score(GS)and stage.Results:There were 39 patients included,of which 35(90%)had mp-MRI done post-biopsy.A total of 93 cancer foci were identified on whole-mount pathology,of which mp-MRI detected 63(68%).Of those detected by mp-MRI,14 were PI-RADS 3(n=6 for GS 6,n=8 for GS 7,no GS≥8)and 49 were PI-RADS 4e5(nZ7 for GS 6,nZ33 for GS 7,and nZ9 for GS≥8).There were 30(32%)cancer foci missed by mp-MRI(n=15 for GS 6,n=13 for GS 7 and n=2 for GS≥8).A lesion classified as PI-RADS 4e5 predicted a higher grade cancer on pathology as compared to PI-RADS 3(for GS 7 lesions,odds ratio[OR]=3.53,95%CI:0.93e13.45,p=0.064).The mp-MRI size detection limit was 20 mm2 and 100 mm2 for 50%and 75%probability of cancer,respectively.In associating with radiological and pathologic stage,the weighted Kappa value was 0.69(p<0.0001).The sensitivity and positive predictive values for this study were 68%(95%CI:57%e77%)and 78%(95%CI:67%e86%),respectively.Conclusion:In this predominantly post-biopsy cohort,mp-MRI using PI-RADSv2 reporting has a reasonably high diagnostic accuracy in detecting clinically significant prostate cancer.

产前胎盘超声评分法联合MRI对前置胎盘合并胎盘植入的诊断价值研究

目的分析产前胎盘超声评分法联合核磁共振成像(MRI)对前置胎盘合并胎盘植入的诊断价值。方法选取2021年6月~2023年12月在中山市博爱医院产科门诊就诊的102例既往有剖宫产史或宫腔操作史、中晚孕期前置胎盘且疑似胎盘植入患者为研究对象,在晚孕期(≥28周)分别对所有研究对象进行产前胎盘超声、MRI检查。以病理诊断结果为金标准,分析胎盘超声评分法、MRI、胎盘超声评分+MRI(联合诊断)三种检查方式对前置胎盘合并胎盘植入的诊断价值。结果术后病理诊断结果显示,102例疑似胎盘前置合并胎盘植入患者中,66例确诊,36例为非胎盘前置合并胎盘植入患者;胎盘超声评分法诊断确诊63例胎盘前置合并胎盘植入患者;MRI诊断确诊62例,联合诊断确诊79例。三种检查方式对比,特异度、准确度、阳性预测值无明显差异(P>0.05),灵敏度、阴性预测值存在显著差异(P<0.05)。联合诊断的灵敏度、阴性预测值显著高于胎盘超声评分法、MRI诊断(P<0.05);联合诊断的准确度高于MRI诊断(P<0.05)。胎盘超声评分法、MRI诊断对比,灵敏度、特异度、准确度、阴性预测值均无显著差异(P>0.05)。ROC曲线分析结果表明,三种检查方式的AUC均>65%,联合诊断的AUC最大(81.23%)。结论产前胎盘超声评分法联合MRI对前置胎盘合并胎盘植入具有较高的诊断价值。

酰胺质子转移成像在前列腺癌中的应用进展

酰胺质子转移(APT)成像是检测酰胺质子对自由水中氢质子交换饱和的成像技术,通过检测细胞中蛋白质、多肽水平反映肿瘤的恶性程度和侵袭性。就APT成像及其联合T2mapping、扩散加权成像(DWI)、体素内不相干运动(IVIM)成像、mDIXON-Quant序列和前列腺特异性抗原(PSA)等在前列腺癌诊断、危险度分层及骨转移预测等方面的研究进展进行综述。

超声评分系统联合MRI预测穿透性胎盘植入的临床价值

目的:探讨超声评分系统联合MRI鉴别诊断穿透性与非穿透性胎盘植入的临床价值,提高对穿透性胎盘植入的预测。方法:回顾性分析2019年1月~2022年1月海南医学院第一附属医院收治的76例胎盘植入患者的临床及影像资料,所有患者产前均行超声评分及MRI检查,依据产后病理学及临床诊断将其分为穿透性组(n=8)与非穿透性组(n=68),分析两组影像图像特征,并比较两组单独的超声评分、MRI征象与超声评分联合MRI检查诊断穿透性胎盘植入的灵敏性、特异性、准确率。结果:超声评分总值≥10分时,穿透性组的发生率75.00%(6/8)高于非穿透性组[2.94%(2/68)];超声评分总值3~9分时,非穿透性组的发生率[73.53%(50/68)]高于穿透性组[25.00%(2/8)]。穿透性组子宫肌层信号中断[87.50%(7/8)]高于非穿透性组[10.29%(7/68)],胎盘侵犯宫旁组织[87.50%(7/8)]高于非穿透性组[0.00%(0/68)],差异有统计学意义(P<0.05)。超声评分联合MRI诊断穿透性胎盘植入的灵敏度、特异度、准确率性均高于单独的超声、MRI检查。结论:超声评分≥9分且MRI出现子宫肌层信号中断、胎盘侵犯宫旁组织等征象可预测胎盘穿透性植入,对穿透性胎盘植入的诊断具有较高的灵敏度、特异度、准确率,为临床鉴别诊断穿透性与非穿透性胎盘植入提供较高参考价值。

表观扩散系数值在预测低中危前列腺癌Gleason分级中的价值

目的:探讨表观扩散系数(ADC)值对低中危前列腺癌(PCa)的诊断效能及其与Gleason评分(GS)之间的相关性。方法:收集2020年1月至2021年12月南京鼓楼医院前列腺受检者的临床影像数据进行回顾性分析。测量病灶的ADC值,分析ADC在低中危PCa诊断中的效能,以及ADC值与GS之间的相关性,比较平均表观扩散系数值(ADC_(mean))和最小表观扩散系数值(ADC_(min))的诊断效能。结果:纳入1051例患者,病灶总数为1202个,其中638个为PCa(53.08%),564个为良性病变(46.92%)。良性病变组的ADC_(min)及ADC_(mean)明显高于PCa组,差异具有统计学意义(P<0.01)。GS 4+3组的ADC_(min)及ADC_(mean)显著低于GS 3+4组、GS 3+3组和良性组,差异均有统计学意义(P<0.01)。诊断PCa的ADC_(min)和ADC_(mean)的AUC分别为0.911、0.972,诊断界值分别为0.703×10^(-3)mm^(2)·s^(-1)、0.896×10^(-3)mm^(2)·s^(-1)。ADC_(min)、ADC_(mean)与GS呈负性相关(ρ_(s)=-0.764,P<0.001;ρ_(s)=-0.845,P<0.001)。结论:ADC值与低中危PCa侵袭性呈负相关,对GS 3+4、GS 4+3病灶具有较高的鉴别诊断价值,敏感度、特异度高,且ADC_(mean)的诊断价值更高,可对PCa生物学特性进行有效的术前评估,辅助临床医师制订治疗方案,有效避免过度治疗。

DCE-MRI结合DWI对前列腺癌Ki-67表达和Gleason评分的预测价值

目的旨在评估动态对比增强磁共振成像(dynamic contrast-enhancement magnetic resonance imaging,DCE-MRI)结合扩散加权成像(diffusion weighted imaging,DWI)在预测前列腺癌(prostate cancer,PCa)Ki-67表达和Gleason评分中的诊断效能。材料与方法回顾性分析了2019年1月至2023年10月自贡市第四人民医院收治的66例PCa患者的临床及影像资料。结合T2WI、DWI序列和由DWI自动计算出的表观扩散系数(apparent diffusion coeffieient,ADC),在DCE-MRI图像上手动勾画肿瘤感兴趣区(region of interest,ROI),计算ROI药代动力学参数,包括容积转运常数(volume transfer contrast,K^(trans))、速率常数(rate contrast,K_(ep))、血管外细胞外容积分数(extravascular extracellular volume fraction,Ve),并测量ADC值。根据靶向穿刺病理诊断Gleason评分和Ki-67表达水平,分为Ki-67高表达组(Ki-67>10%)和低表达组(Ki-67≤10%),Gleason评分低级别(GG 1~2)和高级别(GG 3~5)组。组间差异比较使用两独立样本t检验或非参数检验,采用Spearman相关分析评价DCE-MRI参数和ADC值与Ki-67、Gleason评分的相关性,并建立logistic回归模型,通过受试者工作特征(receiver operating characteristic,ROC)曲线评估诊断效能。结果ADC值与Ki-67表达、Gleason评分均呈负相关(P<0.001),K^(trans)、K_(ep)、Ve与Ki-67表达均呈正相关(P<0.001),K^(trans)、K_(ep)与Gleason评分均呈正相关(P<0.001)。Ki-67高、低表达组K^(trans)、K_(ep)、Ve、ADC值比较差异均具有统计学意义(P<0.01),Gleason评分高、低级别组K^(trans)、K_(ep)、ADC值比较差异均具有统计学意义(P<0.01);Ki-67表达的ROC曲线分析显示,联合模型K^(trans)+K_(ep)+Ve+ADC诊断效能最好,曲线下面积(area under the curve,AUC)为0.940;Gleason评分分级的ROC曲线分析显示,联合模型K^(trans)+K_(ep)+ADC诊断效能最好,AUC为0.861。结论DCE-MRI的药代动力学参数和ADC值相结合,在预测PCa的Ki-67表达和Gleason评分中显示出高诊断效能。联合使用DCE-MRI定量参数与ADC值可提高PCa病理分级和生物侵袭性的预测准确性。

基于Kaiser评分临床-多参数MRI诊断模型在乳腺良恶性病变鉴别诊断中的价值

目的建立基于Kaiser评分(Kaiser score,KS)临床-多参数乳腺MRI影像诊断模型,并探讨其在乳腺良恶性病变诊断及鉴别中的价值。材料与方法回顾性分析2019年1月至2022年12月经病理证实乳腺肿瘤患者389名(共403例病灶)的术前MRI及临床病理资料,其中良性组100例及恶性组303例。记录基于KS中的MRI图像特征、表观扩散系数(apparent diffusion coefficient,ADC)值及相关临床指标,单因素分析比较乳腺良恶性病变组间各指标之间的差异,多因素logistic回归分析筛选乳腺恶性病变的独立危险因素,建立临床-多参数MRI影像诊断模型,绘制受试者工作特征(receiver operating characteristic,ROC)曲线评估其诊断效能,DeLong检验比较临床-多参数MRI影像诊断模型与单纯KS的诊断效能。结果乳腺良恶性病变组间根征、时间-信号强度曲线(time-signal intensity curve,TIC)类型、边缘、内部强化、水肿、ADC值、年龄、妇科肿瘤病史、绝经史差异有统计学意义(P<0.001),多因素logistic回归分析显示病灶根征阳性、TIC为Ⅲ型、边缘不光整、年龄大、存在妇科肿瘤史[比值比(odds ratio,OR)=7.889、7.707、4.398、1.122、0.239,P<0.05]是乳腺恶性病变的独立预测因子,基于KS相关特征、年龄、妇科肿瘤史建立临床-多参数MRI影像诊断模型。以乳腺良恶性为标准绘制KS及临床-多参数MRI影像诊断模型的ROC曲线,敏感度分别为97.4%、91.1%,特异度为69.3%、84.2%,曲线下面积(area under the curve,AUC)值为0.912、0.950;DeLong检验显示两者的AUC差异有统计学意义(P=0.006)。腋窝淋巴结(axillary lymph node,ALN)转移阳性组与阴性组在乳腺癌根征(χ^(2)=6.477,P=0.011)、瘤周水肿(χ^(2)=12.241,P<0.001)、ADC值(Z=10.988,P=0.015)差异有统计学意义。多因素logistic回归分析显示瘤周水肿(OR=2.807,P=0.006)会增加ALN转移风险,存在瘤周水肿增加ALN转移的风险是无此特征患者的2.807倍。结论KS对乳腺病灶有较高的诊断价值,基于KS的临床-多参数MRI影像诊断模型有助于提高乳腺良恶性病变的诊断效能,且乳腺MRI原发灶存在瘤周水肿可作为乳腺癌ALN转移的独立预测因子。

Kaiser评分与表观扩散系数对哺乳期乳腺良恶性病变的鉴别诊断效能研究

目的评估Kaiser评分与表观扩散系数(apparent diffusion coefficient,ADC)对哺乳期乳腺病变良恶性的鉴别诊断效能。材料与方法回顾性分析2016年10月至2023年10月于郑州大学第三附属医院行术前乳腺MRI检查的65例哺乳期乳腺病变患者的临床、病理及影像资料,根据病理结果将这些病例分为恶性组31例,良性组34例。每位患者选取一个主病灶进行Kaiser评分和ADC值测量,将Kaiser评分大于4的病灶根据其ADC值进行二次评分,得到新的预测指标Kaiser+。以病理结果为金标准,使用受试者工作特征(receiver operating characteristic,ROC)曲线评价ADC值、Kaiser评分和Kaiser+评分的诊断效能,计算其曲线下面积(area under the curve,AUC)、敏感度、特异度和准确度,并通过DeLong检验对三者的AUC进行比较。结果ADC值的AUC为0.818[95%置信区间(confidence interval,CI):0.709~0.927];Kaiser评分的AUC为0.881(95%CI:0.791~0.971);Kaiser+评分的AUC为0.910(95%CI:0.931~0.990);Kaiser+评分与ADC值的AUC(0.910 vs.0.818)差异具有统计学意义(P=0.011),Kaiser评分与ADC值的AUC(0.881 vs.0.818)差异无统计学意义(P=0.141),Kaiser+评分与Kaiser评分的AUC(0.910 vs.0.881)差异无统计学意义(P=0.151)。结论Kaiser+评分相较于ADC值具有更高的诊断效能,可以较为准确地鉴别哺乳期乳腺良恶性病变,为临床制订个性化的治疗方案提供参考。

基于MRI征象及临床因素的评分系统预测胎盘植入性疾病的价值

目的:探讨基于MRI征象及临床因素的评分系统预测胎盘植入性疾病(PAS)的应用价值。方法:回顾性分析132例孕妇的临床及MRI资料,其中非PAS组80例,PAS组52例(其中黏连型胎盘植入(PA)亚组25例、植入型胎盘植入(PI)/穿透型胎盘植入(PP)亚组27例)。采用5分评分法对MRI征象及临床因素进行评分。统计分析各参数的组间差异性以及与PAS的相关性,采用ROC曲线分析各个相关参数对PAS的诊断效能。利用二元Logistics回归分析构建MRI+临床诊断模型,并运用ROC曲线分析该模型的诊断效能。结果:两位医师对MRI征象评分的一致性极好(ICC>0.9,P<0.05)。孕次评分、产次评分、子宫手术史评分、胎盘位置评分、11个征象总分及7个共识征象总分在非PAS组与PAS组间差异具有统计学意义并均与PAS呈正相关性(P<0.05),其中7个共识征象总分相关性最高(r=0.635)。孕次评分、产次评分、子宫手术史评分、胎盘位置评分、11个征象总分及7个共识征象总分预测PAS的ROC曲线下面积(AUC)分别为0.625、0.684、0.778、0.741、0.868、0.875(P<0.05)。ROC曲线分析结果显示,MRI+临床诊断模型预测PAS组与非PAS组、非PAS组与PA亚组、PA亚组与PI/PP亚组的AUC分别为0.892、0.795、0.871(P<0.05)。结论:基于MRI及临床相关因素的评分系统可以较准确地预测PAS及其植入深度,具有较高的应用价值。

DTI定位责任椎间盘在腰椎间盘等离子射频治疗中的运用

目的评估3.0T磁共振(MR)弥散张量成像(DTI)在多节段腰椎间盘突出症患者的诊断及等离子射频治疗中的价值。方法多节段腰椎间盘突出症行腰椎等离子射频治疗患者60例,随机分成两组,A组为神经阻滞定位责任椎间盘组,B组为DTI定位责任椎间盘。比较患者压缩和非压缩神经根之间的分数各向异性(FA)和表观扩散系数(ADC)的差异,然后比较A组与B组患者等离子射频治疗前,治疗后3 d、7 d、1个月采用视觉模拟评分法(VAS)评分法评估疼痛情况。治疗后1个月MacNab评分法判断疗效。结果责任节段FA值显著低于同一水平非责任节段FA值,责任节段ADC值显著高于同一水平非责任节段ADC值,两者均具有统计学意义。A组术后和B组术后较术前比都有治疗效果。B组术后3 d、7 d、1个月疗效较A组更优。MacNab评分无明显统计学差异(P>0.05)。结论通过3.0T磁共振DTI可准确定位受压的腰骶神经根,对临床准确诊断和术前定位及治疗具有指导意义。

左心室室间隔瘢痕对左束支起搏术实现左束支夺获的影响

目的:通过心脏磁共振探索室间隔瘢痕对左束支起搏实现左束支夺获的影响。方法:回顾性分析52例拟接受左束支起搏的患者,根据是否实现左束支夺获分为失败组和成功组,并通过心脏磁共振对室间隔瘢痕分节段进行评分。结果:上室间隔瘢痕评分是预测左束支夺获成功与否的独立预测因子。当上室间隔的瘢痕<25%,左束支夺获的成功率为100%。而当瘢痕≥50%,左束支夺获的失败率为100%。结论:采用心脏磁共振评估上室间隔瘢痕有助于预测左束支起搏手术成功与否,为手术的顺利实施提供可靠的参考依据。

基于Kaiser评分的MRI影像特征列线图模型术前预测肿块型乳腺癌脉管侵犯的价值

目的评估基于Kaiser评分的MRI影像特征列线图模型术前预测肿块型乳腺癌脉管侵犯的价值。方法回顾性分析经手术病理证实的345例肿块型浸润性乳腺癌患者临床、病理、影像学和Kaiser评分资料,按照7∶3随机分为训练集(n=242)和验证集(n=103)。应用单因素和多因素Logistic回归模型分析肿块型乳腺癌脉管侵犯的独立危险因素并构建列线图预测模型,通过受试者工作特征(receiver operating characteristic,ROC)曲线、校准曲线和临床决策曲线评估模型效能。结果单因素Logistic回归分析发现,肿瘤最大直径、Kaiser评分、扩散加权成像信号、形状和相关受侵征象与肿块型乳腺癌脉管侵犯相关(均P<0.05);进一步的多因素Logistic回归分析显示,Kaiser评分≥6分、扩散加权成像高信号、形状不规则和存在相关受侵征象是肿块型乳腺癌脉管侵犯的独立危险因素(均P<0.05)。Kaiser评分联合扩散加权成像信号、形状和相关侵犯征象构建的肿块型乳腺癌脉管侵犯列线图预测模型在训练集和验证集中的ROC曲线下面积(area under the ROC curve,AUC)分别为0.899(95%CI:0.859~0.939)和0.827(95%CI:0.744~0.909);训练集中特异性为0.845,敏感性为0.840;验证集中的特异性为0.787,敏感性为0.750;校准曲线和Hosmer-Lemeshow拟合优度检验结果表明列线图模型一致性较好;临床决策曲线结果显示列线图预测肿块型乳腺癌脉管侵犯可获得较高收益。结论本研究构建的基于Kaiser评分的MRI影像特征列线图模型有助于术前预测肿块型乳腺癌脉管侵犯,并且该模型具有较高的预测效能,可为临床术前评估肿块型乳腺癌脉管侵犯提供参考依据。